Medicamentous Therapy Research Articles

Therapeutic Apheresis in Metabolic Syndrome.

Background:The metabolic syndrome unites three pathologies of the person – obesity, arterial hypertension and diabetes. In recent years the progressing of such distribution covering from 2.5% to 3.8% of the population with increase twice each 10-15 years is noted. Even at maintenance of level of sugar at diabetes accumulation of the secondary metabolites breaking small vessels isn't excluded. At the same time many life-endangering complications develop.Objective:To identify the possibilities of plasmapheresis in the prevention and treatment of complications of metabolic syndrome.Method:Analysis of the world literature data on complications of metabolic syndrome and methods of their treatment.Results:At metabolic syndrome the frequency of strokes and myocardial infarctions there is twice more often than in population. For 5-9 years the general life expectancy decreases. Disorders of microcirculation at diabetes lead to a retinopathy with total loss of sight, a nephropathy from the outcome in a renal failure, to polyneuropathy and diabetic foot syndrome with high risk of high level amputations of the lower extremities. At the same time medicamentous therapy is not able to prevent such complications and almost only way of removal of these pathological metabolites is therapeutic apheresis, mainly the plasmapheresis. Data from our own studies confirm the effectiveness of such tactics.Conclusion:Plasmapheresis has to be applied not only to the correction of already critical conditions, but also to their prevention.

Medicament therapy tendencies in hospitalized patients with chronic acute heart failure with preserved and reduced ejection fraction

Въведение / цели Целта на нашето проучване беше да се установят тенденциите в прилаганото медикаментозно лечение при хоспитализирани по повод на сърдечна недостатъчност (СН) пациенти със запазена и потисната фракция на изтласкване. Това е постигнато чрез обобщаване и сравняване на информацията за предписваните медикаменти и потенциалните противопоказания и причини за неспазване препоръките за лечение на сърдечна недостатъчност. Материали и методи Това е ретроспективно проучване, обхващащо 535 пациенти, хоспитализирани в УМБАЛ „Света Марина` - Варна за периода от януари 2010 до декември 2014 година с диагноза хронична обострена сърдечна недостатъчност. Сравнени са процентите на предписваните кардиоактивни медикаменти - блокери на РААС, бета-блокери, антагонисти на минералкортикоидните рецептори и калциеви антагонисти при пациенти с хронична СН и редуцирана и запазена ФИ. Резултати За последната 2014 година пациентите със СН са били предимно възрастни (средна възраст 72 години) жени (54.5%), по-често със СНзФИ (37.6%). При пациентите със запазена ФИ (сравнени с тези с редуцирана) приеманите бета-блокери, блокери на РААС и антагонисти на минералкортикоидните рецептори са били значимо по-малко (82.3%, 58.1% и 25.8% спрямо 84.6%, 64.1% и 64.1%), докато процентът на приеманите калциеви антагонисти - по-голям (40.3% спрямо 38.5%) в сравнение с групата със СНрФИ. Процентът на неспазване на препоръките за лечение на СНрФИ с оглед на противопоказанията е 25.6%, 12.8% и 17.9% съответно за блокери на РААС, бета-блокери и антагонисти на минералкортикоидните рецептори. Заключение Има съществени разлики в лечението на СНрФИ и СНзФИ. Пациентите със СНзИФ приемат по-малко бета-блокери, блокери на РААС и антагонисти на минералкортикоидните рецептори, a повече калциеви антагонисти. Висок е процентът на неспазване на препоръките за лечение на СНрФИ спрямо останалата част от Европа, съобразен с противопоказанията. Тенденцията на хоспитализации по повод на СН е да са по-възрастни пациенти, с преобладаващ женски пол и СНзФИ.

CLINICAL EXPERIENCE OF USING SUBMILISECOND Nd:YAG-LASER RADIATION 1064 NM AND CREAM WITH 1% OF IVERMEKTIN FOR TREATMENT OF PAPULOPUSTULAR FORM OF ROSACEA

Rosacea is a polyethiological disease at the base of it progress is pathologically changed innervation of vessels of the skin of face - angioneurosis and it undergoes several stages of development. Initially, against the background of permanent extension, the vascular wall loses elasticity and the blood plasma penetrates it. Microcirculation disorders lead to hypostasis of tissues. This process leads to change of a biota of the face skin - to the uncontrollable growth of number of a Demodex tick, which is one of the ethyopathogenetics factor of promotion from erythemoteleangiectatic form to papulopustular. Etiological reasonable approach for therapy of papulopustular rosacea is a combination of external and physiotherapeutic methods of therapy. As medicamentous therapy for suppression of excess activity of a Demodex tick and its uncontrollable growth in our research we have taken the cream with 1% of Ivermektin. As a physiotherapeutic influence - the submilisecond Nd:YAG-laser radiation (1064 nm). This radiation influences at expanded vessels, sanifies pustules, moderate temperature increase in a derma to 41-42оС, leads to elimination of puffiness and stage-by-stage restructuring of collagen fibers.

P772Effectiveness of medicamentous therapy in children with pacing-induced cardiomyopathy

P772Effectiveness of medicamentous therapy in children with pacing-induced cardiomyopathy

Conservative therapy options for the treatment of coxarthrosis in the early stage of the condition

Aim: Arthrosis of the hip joint is a condition that is becoming more and more common-it affects 1% of the population and constitutes a serious problem for their working efficiency and active way of life. The deforming arthrosis limits the functional capacity of the affected patients, worsens their quality of life and leads to incapacitation of the patients. The treatment of patients with coxarthrosis has to be planned and carried out comprehensively, in accordance with the pathological findings, the stage, duration and individual abilities of each patient. In the early stages of the condition, conservative therapy plays an essential role in the prophylaxis of complications and in slowing down the process. Physical and rehabilitation methods, in combination with medicamentous therapy, yield good results. This article focuses on the application of the comprehensive effect of conservative physiotherapeutic methods and complementary drug therapy in the early stage of coxarthrosis. The aim of the study is to investigate the efficiency of the combined application of physiotherapeutic electrical procedures and kinesitherapy methods and means in the treatment of coxarthrosis in the initial stage. Material and Methods: 18 out-patients with coxarthrosis at an average age of 68, were subjected to a treatment schedule including: interferential current, low-frequency magnetic field, ultra phoresis with non-steroid anti-inflammatory medications, followed by a program of remedial exercise administered in 2 courses of 7 d at ‘St. Panteleymon’ Hospital in Plovdiv, in the period from September 2017 to May 2018. Results: The range of motion in terms of degrees exhibits a tendency towards increasing at the end of the course of therapy, as compared to that at the beginning of the course. The results from the initial and final muscle tests of the hip joint showed an improvement of the muscle function (from a degree of 3.50 to a degree of 4.50). Conclusion: In patients with coxarthrosis in the initial stage, the pain subsides after the physical and rehabilitation therapy administered in combination with medications.

The substantiation of the application of the high-intensity pulsed magnetic field for the combined treatment of biliary sludge

The objective of the present study was to evaluate the effectiveness of the application of the high-intensity pulsed magnetic field in the combination with the intake of mineral water (MW) and rational pharmacotherapy as the components of the combined treatment of biliary sludge. The study included 117 patients presenting with biliary sludge (BS) who were randomly allocated to three groups. Group 1 was comprised of 38 patients and served as the control group. These patients received medicamentous therapy (hymecromone - 200 mg 3 times daily during two weeks and ursodeoxycholic acid at a dose of 10-15 mg/kg a day during a period from 3 to 6 months). The second group consisted of 40 patients and served as the group of comparison. The patients of this group received medicamentous therapy in the combination with the intake of 'Sernovodskaya' hydrocarbonate-chloride-sulphate sodium mineral water (from a spring in the Chechen republic). The third group was composed of 39 patients and constituted the main study group. These patients completed a course of therapy with the use of the high-intensity pulsed magnetic field applied to the gall bladder region. Each patient underwent 10 sessions of magnetic therapy after the completion of the treatment with hymecromone and 'Sernovodskaya' mineral water. The treatment was carried out with simultaneous monitoring dynamics of the clinical symptoms of biliary sludge, the ultrasound examination of the abdominal organs with the evaluation of the contractile function of the gall bladder, the level of bilirubin in the cystic bile, bile acids, cholesterol, and cholate-cholesteric coefficient. The combined treatment of the patients suffering from BS including the application of the high-intensity pulsed magnetic field alleviated the clinical symptoms of the disease much faster than medicamentous therapy combined with the intake of 'Sernovodskaya' mineral water. Moreover, it promoted the restoration of the motor activity of the gall bladder and accelerated the evacuation of the hyperechoic particles. The course of the combined treatment of the patients presenting with biliary sludge including the application of the high-intensity pulsed magnetic field in the combination with the intake of mineral water (MW) and rational pharmacotherapy significantly relieved abdominal pains, alleviated the symptoms of biliary dyspepsia, and improved the motor function of the biliary tract. These therapeutic effects persisted as long as 3 months. The results of the present study give evidence of the necessity of prescription of an optimum dose of ursodeoxycholic acid to the patients suffering from biliary sludge.

Hypertension and cardiometabolic disease.

Hypertension has a central role in cardiometabolic disease and is usually associated with metabolic disorders, such as insulin resistance, obesity, and dyslipidemia. Hyperinsulinemia may increase cardiovascular (CV) risk through its promotion of hypertension, which is possibly a result of chronic enhancement of sympathetic nervous system activity, stimulation of the renin-angiotensin-aldosterone system leading to increased renal tubular sodium reabsorption, modulating cation transport, or inducing vascular smooth muscle cell hypertrophy. The body mass index value is associated with hypertension, but additional analyses showed that the strongest link existed between visceral obesity and hypertension. In a cross-sectional study, we have already shown that pulse pressure (PP) amplification, heart rate (HR), and pulse valve velocity (PWV), but not augmentation index (Aix), are increased in patients with metabolic syndrome (MS). The basis of therapy for hypertension in MS lies in a changed way of life, involving caloric intake reduction, increased quality of food, increased physical activity, and medicamentous therapy. Such a therapy has a favorable impact not only on blood pressure (BP), but on all the components of MS, and is able to delay the onset of diabetes.

ЛАЗЕРНО-УЛЬТРАЗВУКОВАЯ ТЕРАПИЯ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ

The objective of the study: to investigate the efficiency of treatment of those suffering from chronic obstructive pulmonary disease ( COPD ) when using lase r-u ltrasound effect along with traditional therapy. Subjects and methods. 58 COPD patients were enrolled into the study. The article describes the number of clinical, laboratory and functional rates, parameters of external respiration functions, biomarkers of system inflammation during treatment including the lo w-i ntensity laser radiation, exposure to ultrasound and basic medicamentous therapy. Results. The laser ultrasound therapy as a part of comprehensive treatment of COPD patients allows achieving the maximum effect for the following criteria: excretion of sputum (the amount of sputum produced during 24 hours), the subjective assessment of cough and sputum by visual analogue scale; improvement of peripheral blood rates, reduction of system biomarkers ( I L -4 , I L -8 , TN F -2 ), improvement of external respiration function and general state of the patients.

Comprehensive rehabilitation of herniated disc in the lumbar section of the spine

Herniated disc is one of the most common problems of the musculoskeletal system, and the spine, in particular. This article presents a modern algorithm of methods of treatment constituting comprehensive rehabilitation of herniated disc in the lumbar section of the spine, including: physical therapy, active and passive kinesitherapy, medical massage and manual techniques, applied in the medical practice. Rehabilitation and physioprophylaxis facilitate the reduction of the risk of occurrence and development of herniated disc in the lumbar section of the spine through natural (water, air, movement and sunshine) and preformed physical factors, the main aim being achieving a good quality of life of both the sick and the healthy. The so called ‘spine school’, which includes training the patient to have a good posture, a good stance, to walk correctly and to improve his/her motor stereotype through control and self-control, plays a major role. In developing the individual treatment scheme for each patient at a certain stage of his/her condition, it is vital to attempt to achieve a synergic effect of the optimal combination of electrotherapeutic, peloid therapeutic and kinesitherapeutic methods. Regular courses in physioprophylaxis and kinesio-prophylaxis significantly boost the effect of the medicamentous therapy in patients with herniated lumbar disc and improve their quality of life.

Clinical care of acanthamoeba keratitis patients

Recently, akanthamoeba keratitis (AK) is seen more and more often in ophthalmological practice. However, today there are no standard guidelines concerning diagnosis and treatment of patients with AK. In the article, the experience in care for such patients is presented.
 Purpose: to estimate the efficiency of diagnosis and treatment of patients with AK.
 Materials and methods. Case histories of patients, who received treatment for akanthamoeba keratitis in the Eye Microsurgery Department No. 4, City Ophthalmologic Center of the City Hospital No. 2, from 2011 to 2016, were analyzed. Under observation, there were 25 patients (26 eyes) with akanthamoeba keratitis aged from 18 to 77 years; there were 15 men and 10 women. Patients were observed during 1 year. Full ophthalmologic examination was conducted in all patients. Additional diagnostic methods included microbiological investigation of corneal scrapes and washings, culturing them on innutritious agar (with E. сoli covering), confocal corneal microscopy (HRT 3 with cornea module, Heidelberg Retina Tomograph Rostock Cornea Module). A superficial punctate keratits (AK stage 2) was found in one patient. All other patients were divided into two groups. Stromal ring-shaped keratitis was diagnosed in patients of the first group (7 patients, AK stage 3). The 2nd group consisted of 17 patients with corneal ulcer (AK stage 4). All patients received medicamentous treatment. However patients of the 2nd group required different kinds of surgical treatment.
 Results. In AK diagnosis, corneal confocal microscopy is the most informative method. In patients with AK stages 2 and 3, there was an improvement in visual functions as a result of medicamentous therapy. As a result of treatment at the discharge from the hospital, the best corrected visual acuity was 0.5-1.0 for most patients. In the 2nd group patients, who were subjects to different types of surgical treatment visual functions stabilized. However non-compliance with recommendations led to disease recurrences with worse outcomes in four cases.
 Conclusion. It is possible to stop the inflammatory process preserving at the same time high visual functions only when patients are addressed in time, and when appropriate AK therapy is prescribed and patients are compliant with it for a long time.

Порівняльні аспекти впливу різних методів лікування генітального ендометріозу на якість життя

The objective: to study comparative aspects of influence of various methods of treatment of a genital endometriosis on quality of life of patients. Materials and methods. Were included in research of 90 patients aged from 18 till 45 years (middle age of 30.8±0.4 years) with an external genital endometriosis. All patients were divided into three groups which were uniform in the age, the greatest part was made by women at the age of 30-35 years (42.2%); to shown complaints, localization of an external genital endometriosis, nature of the executed surgeries. Results. For rising of efficiency of treatment and improvement of quality of life at patients with an external genital endometriosis to recommend differentiated medicamental therapy as part of the combined treatment. Antigestagen can be a preparation of choice of adjyuvante therapy of an external genital endometriosis at women of genesial age at initial stages of disease as expression of side effects is 4.5 times lower, than at reception of analogs of a Gonadotropinum-rileasing-hormone and its application is much better transferred by patients. For the purpose of fast and complete recovery of function of ovaries among patients of genesial age who have at least one of signs of an external genital endometriosis, it is expedient to carry out therapy antigestagene as a part of the combined treatment. Conclusion. In clinical practice to recommend specially developed questionnaire «Quality of life of patients at an external genital endometriosis» for the purpose of identification of change of specific parameters, for an individual approach for choice of medicamental therapy as a part of the combined treatment. Key words: genital endometriosis, treatment, quality of life.

Benign prostatc hyperplasia – medicamentous treatment

Benign prostatic hyperplasia (BPH) is characterized with proliferaton of glandular and stromal components of the prostate. BPH can produce prostate enlargement and caused lower urinary tract symptoms (LUTS). The growth of the prostate depends on patent’s age and influence of sexual hormones, specially dihydrotestosterone. Symptoms can be divided as irritatve, obstructve and postmicturation symptoms. The basic evaluation included medical history, symptom score questionnaire, bladder diary, physical examinaton, urinalysis, creatinine and prostate specific antigen serum concentraton, uroflowmetry and postvoid residual urine. The modality of treatment depends about patents symptoms and results of diagnostic evaluaton. The inital step in the treatment are behavioural and dietary modificatons. In the patients with mild symptoms watchful waiting is first line treatment. In the other patients medicamentous treatment is recommended. Pharmacological management included: alpha adrenoreceptor antagonists, 5-alpha-reductase inhibitors, muscarin receptors antagonists, vasopressin analogue – desmopressin, beta-3 agonists, phosphodiesterase 5 inhibitors, phytotherapy and combinaton therapy. If the medicamentous therapy failed or the complicatons of BPH are present surgical treatment is recommended.

Современные подходы к медикаментозной терапии сочетанных заболеваний матки

Современные подходы к медикаментозной терапии сочетанных заболеваний матки

Optimization of approaches to the improvement of patients’ compliance to treatment of the hard severity degree of diabetes mellitus 2nd type by family therapy involvement

Aim. To improve the quality of the treatment of patients with DM type 2 of hard severity degree at the expanse of the increase of medicamentous compliance to patients by family therapy involvement.Materials and methods. There were observed 174 patients with DM type 2 of hard severity degree, who underwent out-patient treatment. They were divided in groups depending on applied tactics of psychoprophylaxis of compliance disorders.Methods of research: clinical-anamnestic; clinical-psychopathologic; psychodiagnostic, statistical. Research results and their discussion. It was established that the one of node dyscompliance factors in patients with DM type 2 of hard severity degree is a disorder of cognitive functions that testify to the necessity of a side help involvement, including patients’ relatives into the control of medical prescriptions realization. The other dyscompliance factor of patients with DM type 2 to the therapy is an attitude of relatives to his/her disease. There were established two types of patients’ reaction to medical recommendations, appeared as a response of patient’s family members of his/her disease. All these reactions had dyscompliant character that conditioned a necessity of the correction work with patient’s relatives as a factor psychoprophylaxis of disorders of compliance to the therapy in patients with DM type 2. The elaborated system of prophylaxis of disorders of medicamentous compliance to the therapy in patients with DM type 2 of hard severity degree consisted of two links: indirect work with patients and work with patients’ family members with family therapy involvement. The high effectiveness of the elaborated the system of prophylaxis of disorders of medicamentous compliance to the therapy in patients with DM type 2 of hard severity degree was proved. In all patients, who underwent psychoprophylaxis by the elaborated system, the compliance level increased to maximal values.Conclusions. There were established the factors of dyscompliance to the medicamentous therapy in patients with DM type 2 of hard severity degree. The influence of family members’ reaction to patient’s disease on features of patient’s attitude to the therapy was determined.The system of prophylaxis of disorders of medicamentous compliance to the therapy in patients with DM type 2 of hard severity degree that included family therapy and direct work with patients’ relatives was elaborated. Its high effectiveness was noted

Pain Management in Palliative Care

A consistent pain management together with treatment of dyspnoea belongs to the main issues in symptom control in particular in palliative thoracic oncology. Together with the medicamentous therapy the psychologic and social circumstances of the affected patients have to be considered as factors influencing the experience of pain. The therapeutic fundament according to the WHO guideline for cancer pain is the opiate based medicamentous adjustment combined with non-opioids. In principle, this should be performed preferably orally, as simply as possible, according to a fix drug schedule and individually adjusted to the needed dosage. Breakthrough pain has to be treated with rapidly efficacious, non-retarded analgetics. The typical adverse reaction profile for opiates like constipation and initial nausea should be considered prophylactically by applying concurrent medication with adjuvants. Co-analgesic drugs like anticonvulsiva or corticosteroids could support the analgetic effect and are used preferably in case of neuropathic pain. Primary aim in analgesic therapy is to achieve the best possible pain reduction and hence to safeguard quality of life.

EVIDENCE-BASED STROKE REHABILITATION

Stroke can have different clinical characteristics and consequences, with unequal disability and outcome, thus demanding individual approach, specific skills and general knowledge. Treatment of stroke has significantly improved during the last twenty years, mainly because of clinical and experimental studies, adequate medicamentous therapy, and the use of new technologies as well. Use-dependent rehabilitation strategy includes repetitive training with proper adjustment of the program. Other rehabilitation practices should also be incorporated, such as self-care, recreation, and home-based activities. Motivation of the patients, improving quality of life, functional independence, activities of daily life are crucial. Holistic approach means that the patient as a whole should be considered and treated. Scientific evidence is sufficient to confirm the necessity of physical rehabilitation of patients after stroke in order to achieve the optimal results. Current evidence on the effect of physical therapy in stroke rehabilitation is presented.

THE ANALYSIS OF LONG-TERM OUTCOMES AND ADHERENT TO TREATMENT IN PATIENTS AFTER MYOCARDIAL INFARCTION: KHABAROVSK REGISTER DATA

Objective . To evaluate the long-term outcomes and medical treatment in patients during 2.5 years after reference acute myocardial infarction (AMI), to study adherent to medical treatment and the role of various factors affecting the long-term prognosis. Materials and methods . The AMI Register included data about all patients, whom are consistently hospitalized in the regional vascular center (RVC) of Khabarovsk during the period from 01.01.14 till 31.03.14. The 2.5 years outcomes and adherence to treatment were evaluated by using phone interview. Results . According to prospective part of the AMI Register of 292 patients discharged from the regional vascular center (RVC), the vital status in 2.5 years managed to be established at 274 (93.8 %) from which died 45 (16.42 %, or 15.40 % from all discharged patients). In structure of a mortality the proportion of dead from cardiovascular disease (СVD) patients made 86.6 %. The long-term mortality of patients with myocardial infarction with ST-segment elevation was 19.3 %, the myocardial infarction non-ST-segment elevation – 13.2 %; р = 0.632. The new predictors of death 2.5 years after the onset of AMI were cerebrovascular diseases, the absence of the antihypertensive drugs and β-blockers before reference AMI, not prescribing antiplatelet drugs in loading doses in the early hours of the disease. Frequency of real reception of statins was 65.1 %, angiotensin-renin blockers –76.0 %, β-blocker – 73.8 % of patients after AMI. Only 55.9 % patients Received double antithrombocytic therapy (DATT) during a year. By the Moriscors–Green test adherent were only 109 (47.6 %). 79 (34.5 %) know their values cholesterol, blood pressure and blood glucose. Conclusions . Indicators of the remote lethality among patients authentically didn’t differ with a myocardial infarction with ST-segment elevation in AMI and a myocardial infarction non-ST-segment elevation in AMI in the remote period. The register AMI taped failure predictors, showed the insufficient frequency of reception of recommended medicinal drugs in secondary prophylaxis after a referent AMI, especially concerning statines and DATT. The commitment of patients of long medicamental therapy, and also awareness on indicators of quality of treatment (level of a cholesterin, blood pressure) in real clinical practice according to the register were low.

КОМПЛЕКСНАЯ КУРОРТНАЯ ТЕРАПИЯ КОКСАРТРОЗА В СОЧЕТАНИИ С ОСТЕОПЕНИЕЙ У ЖЕНЩИН В СОСТОЯНИИ ПОСТМЕНОПАУЗЫ

Objective: To evaluate the clinical efficacy of the new technology of restorative treatment of coxarthrosis burdened with osteopenia in postmenopausal women in the dynamics of clinical and algofunctional indices. Methods: Observations were made of 120 postmenopausal women aged 50-60 years with coxarthrosis with the concomitant osteopenic syndrome. Researchers were conducted in three representative groups: control (outpatient) received only Natekal D3; the comparison group at the sanatorium received drinking mineral water and radonotherapy; in the main group, patients received additional magnetotherapy. Results: The dynamics of clinical and algofunctional indices testifies to the advantage of complex balneo-, magneto- and rational pharmacotherapy. Conclusion: The expediency of health-resort treatment of coxarthrosis in combination with osteopenia in postmenopausal women with the complex application of radon, magnetic and medicament therapy was proved. Keywords: Coxarthrosis, postmenopause, radonotherapy, magnetotherapy, algofunctional indices.

ПРИМЕНЕНИЕ ДВУХСТУПЕНЧАТОЙ СИСТЕМЫ СКРИНИНГА В КОМПЛЕКСНОЙ ОЦЕНКЕ ПСИХОСОЦИАЛЬНОГО СТАТУСА У БОЛЬНЫХ КОРОНАРНОЙ БОЛЕЗНЬЮ СЕРДЦА

Objective: To study the features of the clinical and psychosocial profile using a two-step screening system in patients with coronary heart disease (CHD). Methods: In 115 patients with the stable CHD, conducted a general clinical examination with an assessment of the psychosocial status using the European Society of Cardiologists Questionnaire, the scales of the anxiety and depression of Hamilton, and the DS-14 questionnaire. Results: Analysis of the clinical status revealed a severe course of CHD in more than 40% of patients prevailing conditional risk factors (arterial hypertension, obesity, dyslipidemia), as well as low adherence to medicamentous therapy (statins, nitrates, calcium blockers, diuretics) and interventional procedures. The psychological status of those surveyed was characterized by a high rate of hostility (36.5%), personality type D (29.5%), anxiety (16.5%) and depression (6.9%), low socioeconomic status (6.9%), stress at work and in family life (6%). Conclusion: The two-step screening system with application of European Society of Cardiologists Questionnaire, Hamilton’s anxiety and depression scales, DS-14 questionnaire are recommended to use for well-timed verification of psychosocial risk factors in coronary heart disease patients with the aim to detect existing barriers to treatment and to optimize treatment and medioprophylactic measures. Keywords: Coronary heart disease, psychosocial factors.

Osteopathic Correction of Somatic Dysfunctions in Children Under One Year of Age Presenting Hypertensive Syndrome

Introduction. Intracranial hypertension is diagnosed in 80 % of mature and almost in 100 % of premature children. The child’s brain especially in the first year of life is very sensible to the hypoxia of different genesis. That is why early diagnostics and treatment of this type of pathology in newborns is very important. The justification of the use of osteopathic treatment of this pathology is of current interest.Research objectives. To find the possibilities of osteopathic correction of somatic dysfunctions in combined therapy of intracranial hypertension in children under one year of age.Research methods. The results of the treatment of the intracranial hypertension were compared in two groups of children. Children from group № 1 (15 children) received medicamentous therapy and osteopathic treatment, which included restoration of the kinetics of the elements of the craniosacral system. Children from group № 2 received only medicamentous therapy. The treatment outcomes were evaluated according to the changes of the neurologic status, which considered presence of general cerebral and focal symptoms, growth of head circumference in comparison with the age norm, intensification of vascular pattern on the skin of the head, separation of cranial sutures.Results. It was found that the number of somatic dysfunctions and complexes of symptoms was reduced in a statistically significant manner in the group of patients who received osteopathic treatment in comparison with the patients from the control group.Conclusion. The research showed that osteopathic correction is effective and can be widely used in combined therapy of intracranial hypertension.